Medically Unlikely Edits for Speech-Language Pathology Services

Medically Unlikely Edits (MUEs), a subset of the National Correct Coding Initiative (CCI), are used for Medicare Part B and Medicaid claims. An MUE for a CPT or HCPCS Level II (supplies, equipment, and, devices) code specifies the maximum number of times that the code can be reported for the same patient on the same day. There are separate MUEs for office and hospital outpatient settings, though the edits for speech-language pathology are similar in both settings. The following tables for speech-language pathology related MUEs for Medicare Part B services are derived from the complete lists of edits published on the Centers for Medicare & Medicaid Services (CMS) MUE website. They list codes that have MUEs and the number of times each code may be billed for the same patient on the same day for both office and outpatient settings.

Medicaid MUEs are not captured here but are listed on the CMS website. State Medicaid agencies may modify the MUEs to meet their own programmatic needs and other third-party payers may also adopt them. Please check with non-Medicare payers regarding their use of MUEs.

An exception may be requested for medically reasonable and necessary services that exceed the MUE limit by reporting certain modifiers, as outlined by CMS.

Note: Not all codes have an MUE. Speech-language pathology CPT and HCPCS Level II codes are listed here only if they have an associated MUE. This not a comprehensive list, though every attempt has been made to include codes typically billed by SLPs. A complete list of MUEs is available on the  CMS website. SLPs should also be aware of National Correct Coding Initiative (CCI) edit restrictions.

Table 1: CPT Code MUEs for Speech-Language Pathology Services

CPT Code MUE Values
  Office Setting Facility Outpatient Setting
31575 1 1
31579 1 1
70371[1] 1 1
74230[1] 1 1
76536[1] 1 1
92507 1 1
92508 1 1
92511 1 1
92512 1 1
92520 1 1
92521 1 1
92522 1 1
92523 1 1
92524 1 1
92526 1 1
92605 0 1
92606 N/A 1
92607 1 1
92608 4 4
92609 1 1
92610 1 1
92612 1 1
92613 1 1
92614 1 1
92615 1 1
92616 1 1
92617 1 1
92618 1 1
92626 1 1
92627 6 6
92700 1 1
96105 3 3
96110[2] 3 3
96111 1 1
96125 2 2
97110 6 8
97127 1 1
97530 6 6
G0515
(replaced 97532 effective January 1, 2018)
8 8
97533 4 4
97535 8 8

 

Table 2: HCPCS Level II MUEs for Speech-Language Pathology

Note:  HCPCS Level II codes are required for claims for supplies and devices typically billed through Durable Medical Equipment (DME) contractors.

HCPCS Code MUE Values
  Office Setting Facility Outpatient Setting
E1902 1 1
E2500 1 N/A
E2502 1 N/A
E2504 1 N/A
E2506 1 N/A
E2508 1 N/A
E2510 1 N/A
E2511 1 N/A
E2512 1 1
L8500 N/A 1
L8501 2 2
L8507 3 3
L8509 1 1
L8510 1 1
L8511 1 1
L8514 1 1
L8515 1 1

See also:

[1] This is a radiology code and should not be billed by speech-language pathologists. See ASHA's Medicare Physician Fee Schedule for Speech-Language Pathologists [PDF] for additional information on services billed by SLPs.

[2] Medicare does not cover screens. See ASHA's Medicare Physician Fee Schedule for Speech-Language Pathologists [PDF] for additional information on services billed by SLPs.

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